Care Ally, RN Case Manager

Company: AllyAlign Health
Location: Quincy
Posted on: November 16, 2022

Job Description:

AllyAlign Health (AAH) is a leading convener and operator of Medicare Advantage plans designed for senior living residents. The company began work in 2014 by enabling leading long-term care providers to launch provider-sponsored managed care plans for vulnerable senior populations. Today, AAH manages special needs plans that aim to reduce healthcare costs and improve patient quality of life. AAH is now a proud member of the Curana Health organization, where, together, a common mission seeks to expand the reach and positive impact on senior living across the country. For more information visitallyalign. com. SUMMARY The Care Ally, RN Case Manager is a key member of the interdisciplinary care team (ICT). They use a collaborative process of assessment, planning, implementing, coordinating, monitoring, and evaluating options and services required to meet the members health and social needs.They act as a liaison between our Members, their Responsible Parties and/or Power of Attorneys (RP/POAs), Advance Plan Provider/PCP, and key Align Senior Care stakeholders. The Care Ally, RN Case Managerreports to the Supervisor of Case Management. This is an on-site role in Miami. This work is mostly in person with some travel. Responsibilities

• Executes on strategies and goals set by the Align Senior Care Board of Directors, the AllyAlign Senior Leadership Team, and Executive Director for managing and improving overall Member experience.
• Contacts Plan members to conduct a comprehensive health assessment of the individual, develop a plan of care, and participate in the facilitys interdisciplinary care team meeting.
• Serves as health coach to educate the member, the family and/or caregiver, about disease status and treatment, plan benefits, community resources, and resource options
• Collaborates with members of the interdisciplinary care team and medical director(s) to facilitate appropriate treatment for members
• Routinely follows up with member as scheduled to assess progress towards goals
• Communicates with the member and/or caregiver to assist with the development of health goals and identify interventions to achieve these goals
• Provide patient-centered intervention; such as making and verifying appointments, performing medication and care compliance initiatives;
• Acts as front-line support with Members and their RP/POAs to ensure the needs of the Member are met. Serves as a connection point among Members, their Communities, their Care Team, and Align Senior Care internal departments.
• Regularly engages Align Senior Care Members and RP/POAs in-person or by phone to provide education and assistance with utilizing Align Senior Care benefits. Including but not limited to. checking on upcoming specialist appointments, connecting members to supplemental benefits and providers, identifying immediate Member needs, and answering any questions the Member or RP/POA may have.
• Communicates Member health updates from Care Team to RP/POAs.
• Coordinates with the Care Team for non-urgent health or clinical questions.
• Works directly with AllyAlign's internal departments to solve Member Grievances, Utilization Management, and Billing related issues.
• Updates Member and RP/POA contact information such as changes of address, email, or phone numbers.
• Actively supports Account Manager in identifying and securing contracts with "preferred" Providers.
• Assists Members, RP/POAs, and Partner Communities with locating in-network providers and scheduling/facilitation of appointments.
• Assists with (on request of member or APP) coordination of home health and therapy visits, ordering of Durable Medical Equipment, and utilization of supplemental benefits for Members.
• Monitors and, if needed, facilitates care team meetings with facility team, member, responsible partie(s) and the APP/clinical team.
• Ensures documentation of care team meetings and transmits to Plan.
• Monitors care plan updates, facilitates APP and PCP input into care plan, and distributes care plan as needed to care team members.
• Monitors midnight reports/community census to help identify member transitions to hospital or other care levels. Education & Experience
  • Registered nurse license, active and unencumbered state license in the state where job duties are performed is required. BSN preferred.
  • One (1) year of clinical practice experience in at least one of the following areas: case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care.
  • Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding.
  • Case management certification preferred. Professional Certification Or Licenses
    Current Unrestricted Registered Nurse License
    - Due to the nature of our business, we require all of our employees to be fully vaccinated against the COVID-19 virus on their first day of employment, in compliance with CMS requirements and all applicable EEOC guidance regarding vaccines and qualified exemptions.

Keywords: AllyAlign Health, Quincy , Care Ally, RN Case Manager, Executive , Quincy, Massachusetts